Ciguatera poisoning is caused by eating fish that have accumulated ciguatoxin produced by the marine microalgae Gambierdiscus toxicus. Symptoms occur within 3-6 hours of ingestion and include nausea, numbness around the mouth, and throat. Respiratory paralysis can occur without treatment. From 1983-1992 there were 129 outbreaks reported to the CDC involving 508 people. Prevention involves avoiding large predatory fish from tropical/subtropical areas most prone to ciguatera.